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VII. INDEPENDENT CONTRACTOR CERTIFICATION STATEMENT <br />Per ORS 670.600, as used in ORS chapters 316, 656, 657, 671 and 701, "independent <br />contractor" means a person who provides services for remuneration and who, in the provision of <br />the services: <br />(1) Is free from direction and control over the means and manner of providing the services, <br />subject only to the right of the person for whom the services are provided to specify the <br />desired results; <br />(2) Is customarily engaged in an independently established business (a person is considered to <br />be customarily engaged in an independently established business if any THREE of the <br />following requirements are met; check all that apply) (NOTE: This provision does not apply <br />if the person files a Schedule F as part of an income tax return and the person provides <br />farm labor or farm services that are reportable on Schedule C of an income tax return); <br />A) You maintain a business location that is separate from the business or work location of <br />the person for whom the services are provided or that is in a portion of your residence <br />and that portion is used primarily for the business. <br />B) You bear the risk of loss related to the business or the provision of services as shown <br />by factors such as you enter into fixed -price contracts; you are required to correct <br />defective work; you warrant the services provided; or you negotiate indemnification <br />agreements or purchase liability insurance, performance bonds or errors and omissions <br />insurance. <br />C) You have provided contracted services for two or more different persons within a 12- <br />month period, or you routinely engage in business advertising, solicitation or other <br />marketing efforts reasonably calculated to obtain new contracts to provide similar <br />services. <br />D) You make a significant investment in the business, through means such as purchasing <br />tools or equipment necessary to provide the services; paying for the premises or <br />facilities where the services are provided; or paying for licenses, certificates or <br />specialized training required to provide the services. <br />E) You have the authority to hire other persons to provide or to assist in providing the <br />services and have the authority to fire those persons. <br />(3) Is licensed under ORS chapter 671 or 701 if the person provides services for which a <br />license is required under ORS chapter 671 or 701; and <br />(4) Is responsible for obtaining other licenses or certificates necessary to provide the services. <br />SIGNATURE: <br />I hereby certify that to the best of my knowledge the information provided is complete and <br />correct. I hereby certify that the business will operate as an independent contractor as stated <br />above. <br />Signature and Printed Name of Owner, Partner, or Corporate Officer Company Date <br />